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Treatment for cigarette, alcohol and drug use in pregnancy improves outcomes for mom and baby
June 26, 2008Pregnant women who receive treatment for substance abuse early in their pregnancy can achieve the same health outcomes as pregnant women with no substance abuse, according to a Kaiser Permanente study published online in the Journal of Perinatology.
The study, which is the largest to date, examined 49,985 women in Kaiser Permanente's prenatal care program and found that integrating substance abuse screening and treatment into routine prenatal care helped pregnant women achieve similar health outcomes as women who were not using cigarettes, alcohol or other drugs. This is also the largest study to examine multiple substances: cigarettes, alcohol, marijuana, methamphetamines, cocaine and heroin.
"This program can happen everywhere and should become the gold standard for women who are pregnant and using cigarettes, alcohol or other drugs," said study lead author Nancy C. Goler, M.D., an OB/GYN and Kaiser Permanente regional medical director of the Early Start Program for the organization's Northern California operations. "The study's big finding was that study participants treated in the Early Start program had outcomes similar to our control group, women who had no evidence of substance abuse."
The study compared 2,073 pregnant women who were screened, assessed and received ongoing intervention during pregnancy through the Early Start program at 21 Kaiser Permanente Northern California outpatient obstetric clinics from 1999 to 2003 to women in three other groups: 156 women who were screened but did not accept assessment or treatment; 1,203 women were screened, assessed and received brief intervention only; and a control group of 46,553 women who showed no evidence of substance abuse.
The study found the risk of stillborn, placental abruption (when the placental lining separates from the mother's uterus), pre-term delivery, low birth weight and neonatal ventilation were dramatically higher for the 156 untreated substance abusers than the 2,073 women in the Early Start program:
* Risk of stillbirth was 16.2 times higher for women who were screened but did not accept assessment or treatment than those who received Early Start treatment
* Risk of placental abruption was 6.8 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
* Risk of pre-term delivery was 2.1 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
* Risk of low birth weight (under 5.5 pounds) was 1.8 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
* Risk of neonatal ventilation was 2.2 times higher for women who were screened but did not accept assessment or treatment than those who received treatment.
The women who went through the Early Start program had the same statistical risks of stillborn, preterm delivery, placental abruption as the control group of women who did not use any cigarettes, alcohol or drugs during their pregnancy.
"The key message here to women who are currently smoking, drinking or using other drugs, or who recently tried to stop, is that it is not too late to seek help when you find out you are pregnant," said Dr. Goler. "The sooner women ask for help, the better the health outcomes will be for themselves, and their babies. My message to all pregnant women, as well as women who are trying to conceive, is to stop all alcohol, cigarette and drug use."
Launched in 1990, Kaiser Permanente's Early Start program integrates obstetric care with substance abuse treatment for pregnant women in three ways: all women are screened by questionnaire for drug, cigarette and alcohol use, and by urine toxicology testing with signed consent; a licensed substance abuse expert works in the OB/GYN department and sees the patients at the same time as their prenatal care appointments; and all providers and patients are educated about the effects of drugs, alcohol and cigarette use during pregnancy.
The program, which is in place in 40 Kaiser Permanente outpatient obstetric clinics in Northern California and being rolled out in other Kaiser Permanente facilities nationwide, screens nearly 40,000 women annually. By providing a licensed professional with expertise in substance abuse and pregnancy in the OB/GYN department - so women have barrier-free access to care in a safe, supportive environment - Early Start exceeds the American College of Obstetricians and Gynecologists Committee on Ethics Opinion recommendations to use universal screening questions, brief intervention, and referral to treatment programs for substance abuse
"This study is a superb example of how effective the Kaiser Permanente's Early Start approach and methodology is in treating chemical dependency and substance abuse in pregnant women," said Margaret Merritt, Executive Director of the American College of Obstetrics and Gynecology, District IX (California). "Early Start exceeds the guidelines set forth by ACOG and is a fantastic example of a program that can be incorporated in a variety of settings to reach this very important group of women."
Kaiser Permanente
The study compared 2,073 pregnant women who were screened, assessed and received ongoing intervention during pregnancy through the Early Start program at 21 Kaiser Permanente Northern California outpatient obstetric clinics from 1999 to 2003 to women in three other groups: 156 women who were screened but did not accept assessment or treatment; 1,203 women were screened, assessed and received brief intervention only; and a control group of 46,553 women who showed no evidence of substance abuse.
The study found the risk of stillborn, placental abruption (when the placental lining separates from the mother's uterus), pre-term delivery, low birth weight and neonatal ventilation were dramatically higher for the 156 untreated substance abusers than the 2,073 women in the Early Start program:
* Risk of stillbirth was 16.2 times higher for women who were screened but did not accept assessment or treatment than those who received Early Start treatment
* Risk of placental abruption was 6.8 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
* Risk of pre-term delivery was 2.1 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
* Risk of low birth weight (under 5.5 pounds) was 1.8 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
* Risk of neonatal ventilation was 2.2 times higher for women who were screened but did not accept assessment or treatment than those who received treatment.
The women who went through the Early Start program had the same statistical risks of stillborn, preterm delivery, placental abruption as the control group of women who did not use any cigarettes, alcohol or drugs during their pregnancy.
"The key message here to women who are currently smoking, drinking or using other drugs, or who recently tried to stop, is that it is not too late to seek help when you find out you are pregnant," said Dr. Goler. "The sooner women ask for help, the better the health outcomes will be for themselves, and their babies. My message to all pregnant women, as well as women who are trying to conceive, is to stop all alcohol, cigarette and drug use."
Launched in 1990, Kaiser Permanente's Early Start program integrates obstetric care with substance abuse treatment for pregnant women in three ways: all women are screened by questionnaire for drug, cigarette and alcohol use, and by urine toxicology testing with signed consent; a licensed substance abuse expert works in the OB/GYN department and sees the patients at the same time as their prenatal care appointments; and all providers and patients are educated about the effects of drugs, alcohol and cigarette use during pregnancy.
The program, which is in place in 40 Kaiser Permanente outpatient obstetric clinics in Northern California and being rolled out in other Kaiser Permanente facilities nationwide, screens nearly 40,000 women annually. By providing a licensed professional with expertise in substance abuse and pregnancy in the OB/GYN department - so women have barrier-free access to care in a safe, supportive environment - Early Start exceeds the American College of Obstetricians and Gynecologists Committee on Ethics Opinion recommendations to use universal screening questions, brief intervention, and referral to treatment programs for substance abuse
"This study is a superb example of how effective the Kaiser Permanente's Early Start approach and methodology is in treating chemical dependency and substance abuse in pregnant women," said Margaret Merritt, Executive Director of the American College of Obstetrics and Gynecology, District IX (California). "Early Start exceeds the guidelines set forth by ACOG and is a fantastic example of a program that can be incorporated in a variety of settings to reach this very important group of women."
Kaiser Permanente
Substance Abuse Current Events and Substance Abuse News RSSNew research on family-based HIV prevention presented at annual NIH conference
Researchers from the Bradley Hasbro Children's Research Center (BHCRC) presented exciting new research today at the National Institute of Mental Health (NIMH) Annual International Research Conference on the Role of Families in Preventing and Adapting to HIV/AIDS.
UNC study: Parenting can override effect of genes in how babies respond to stress
Everyone gets stressed, even babies. Now, it appears how infants respond to stress is linked to if they have a particular form of a certain gene, according to a new study from the University of North Carolina at Chapel Hill.
Monitoring outcomes of suicide attempts in pregnancy can better assess drug dangers
Monitoring the health of children born to women who attempted suicide while pregnant can shed light on which medicines and what doses are particularly dangerous to developing fetuses, according to researchers from Hungary who publish their findings in a series of reports in a special issue of Toxicology and Industrial Health, published this week by SAGE.
Early parenting plays key role in infants' physiological response to stress
In infancy, genes are the key influence on a child's ability to deal with stress. But as early as 6 months of age, parenting plays an important role in changing the impact of genes that may put infants at risk for responding poorly to stress.
New study on rural HIV care has economic and health implications
An Indiana University study found that HIV care providers in rural Indiana report significant stigma and discrimination in the rural medical referral system surrounding issues of HIV and substance abuse. Providers felt that these factors impeded their ability to offer quality care to their patients.
Why delaying gratification is smart: A neural link between intelligence and self-control
If you had a choice between receiving $1,000 right now or $4,000 ten years from now, which would you pick? Psychologists use the term "delay discounting" to describe our inability to resist the temptation of a smaller immediate reward in lieu of receiving a larger reward at a later date.
Abuse of painkillers can predispose adolescents to lifelong addiction
No child aspires to a lifetime of addiction. But their brains might. In new research to appear online in the journal Neuropsychopharmacology this week, Rockefeller University researchers reveal that adolescent brains exposed to the painkiller Oxycontin can sustain lifelong and permanent changes in their reward system - changes that increase the drug's euphoric properties and make such adolescents more vulnerable to the drug's effects later in adulthood.
College freshmen: pain killers and stimulants less risky than cocaine; more risky than marijuana
First year college students believe that occasional nonmedical use of prescription pain killers and stimulants is less risky than cocaine, but more risky than marijuana or consuming five or more alcoholic beverages every weekend.
Study suggests sports stadiums serve alcohol to minors and intoxicated fans
In a novel study looking at the propensity of illegal alcohol sales at sports stadiums, researchers reported that nearly one in five people posing as underage drinkers, and three out of four seemingly intoxicated "fans" were able to buy alcohol at professional sporting events. They also found that location mattered: sales were more likely if the attempt took place in the stadium stands rather than at a concession booth.
Suicidal thoughts among college students more common than expected
More than half of 26,000 students across 70 colleges and universities who completed a survey on suicidal experiences reported having at least one episode of suicidal thinking at some point in their lives. Furthermore, 15 percent of students surveyed reported having seriously considered attempting suicide and more than 5 percent reported making a suicide attempt at least once in their lifetime.
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